King Edward's School - Report of Accident

Accident report form - pupils

If you are reporting CONCUSSION, don't use this form - instead, go to kes.org.uk/headinjury

If the injured person is an adult, please use kes.org.uk/staffaccident
Name of casualty

First NameLast Name
Date of accident

DayMonthYear
Time of accident

:HourMinutesAM/PM Option
Name of the person completing this form
Is the injured person a pupil, or a visiting pupil?

KES Pupil
Year group of pupil
Form
What type of activity were you doing when you were injured?

Other
If a teacher was supervising the activity, state their name
If no teacher supervising, state 'NONE'

What happened?
Location
Where were they (what room, which playing field etc) when the accident happened
Activity
State the sport, activity or subject you were doing at the time
What happened?
Describe what led to the accident
Injury
State what injury(ies) they have suffered
Treatment
Describe what treatment has been provided by the school
Responder
Which adult provided treatment for you in school?
What is happening next?
Any other information
If there is anything else you would like to mention, please type it here.
Witness
If an adult witnessed the accident, state their name
If an adult did not see the accident, but a child did see it, state their name
When you have finished, please click the submit button
Should be Empty:

KES Pupil